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Hello. I'm new and umm due any minute lol Important quuestion!

My 1st baby was born via c-section because she was breech, now this will be my 2nd baby, and I am 37 weeks but just meassured 40w1d by an ultrasound, the Ob just informed me that my baby is about 7 1/2- 8 lbs, and that I might need a c-section because they expect me to deliver a 10 + baby. Now I have no problem with that, but they are really preassuring me since I am trying for a VBAC and their main concern is a uterine rupture... and! they won't induce my labor now, because they said that will put me at a higher risk for a uterine rupture... what should I Do?... How can I induce my labor naturally. and will it actually work on me since I am "supposed" to be only 37 weeks along?..

BABIES born by caesarean section are more vulnerable to asthma, allergies and infection because they miss out on receiving their mothers' good bacteria during birth.

Professor Patricia Conway of the School of Biotechnology and Biomolecular Sciences at the University of New South Wales, said babies delivered vaginally received protective bacteria as they passed through the birth canal during delivery.

This bacteria, left on the baby's skin, could then colonise the intestine and help inoculate newborns against hospital bugs. Gut flora was crucial for developing a balanced immune system. "With a c-section, the newborn baby misses an opportunity to pick up a lot of Mum's good bacteria,'' Professor Conway said.

"This can have long-term health implications, as the development of a good intestinal ecosystem is necessary for health and immunity to allergies, from childhood right through to adulthood."

Professor Conway said emergency caesareans, performed after labour had already begun, meant babies did receive some of the beneficial bacteria, particularly if the waters had broken.

However, elective caesareans were ''sterile'' and gave babies no chance to pick up any of the good bacteria.

Babies had other chances to receive their mother's bacteria, however, during skin-to-skin contact directly after birth, and if they were breastfed.

Australian College of Midwives vice-president Hannah Dahlen said babies born vaginally also had the advantage of hormonal surges during labour that made them more wide-eyed and able to connect with their mothers. Both mother and baby experienced a surge in catecholamines, the fight-or-flight hormone, during labour, making babies more alert at birth.

Recent studies had also shown that white blood cells in babies born by caesarean were different to those of babies born vaginally, potentially altering the way their bodies responded to attacks on their immune systems for the rest of their lives.

The studies could explain dramatic increases in rates of diabetes, testicular cancer, leukaemia and asthma among babies born surgically, said Associate Professor Dahlen.

''In labour, the baby has a gradual escalation in its stress response and then a gradual decline. Research has shown that this could prime our bodies to respond to stress in a certain way,'' she said.

''With a c-section, there is a cold cut and the baby has a dramatic stress response. It could be setting that child up to always over-respond to stress.''

In 2008, European researchers examined 20 previous studies on the link between type 1 diabetes and caesareans, and found babies born surgically had a 20 per cent increased risk of developing diabetes. This might be attributed to surgically born babies having gut microbes picked up from hospital environments.

If you haven’t already heard the screaming in the streets, let me be one of the first (thousand!) to let you know that this afternoon, the American Congress of Obstetricians & Gynecologistsreleased guidelines that aim to lower the repeat cesarean rate as well as saying that women having a VBAC after 2 cesareans or who are carrying twins or women with an undocumented previous incision ALL should be permitted/encouraged to TOLAC (trial of labor after cesarean).

“In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In addition, ‘The College [sic] guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC,’ said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago. “ (emphasis mine)

Am I dreaming?! Could ACOG have actually said something that aligns itself with facts? Beyond stunning.

Also, “Approximately 60-80% of appropriate candidates who attempt VBAC will be successful. (!!!!!!!!!) A VBAC avoids major abdominal surgery, lowers a woman's risk of hemorrhage and infection, and shortens postpartum recovery. It may also help women avoid the possible future risks of having multiple cesareans such as hysterectomy, bowel and bladder injury, transfusion, infection, and abnormal placenta conditions (placenta previa and placenta accreta).”

When the old guidelines were put into place in 2004, a monumental shift occurred that forced hundreds of thousands of women to endure, by force even, a repeat cesarean. The two criteria quoted here, whipped the insurance and hospital admin industry into an apoplectic frenzy.

“…a physician (must be) immediately available throughout active labor who is capable of monitoring labor and performing an emergency cesarean delivery; and the availability of anesthesia and personnel for emergency cesarean delivery.”

Because of these few words, an entire mindshift occurred regarding VBACs and the last six years have been HELL for far too many women.

In March 2010, the National Institutes of Health had a symposium to explore the VBAC “problem” and to try and find solutions. For two-and-a-half days, expert after expert, from OBs to mothers, shared data… scientific data… proving the appropriateness of offering VBAC. I wrote a post, What I Learned Watching the NIH Conference, if you’re interested in reading another perspective of the symposium. I know I am not alone in thinking the words of that conference were inside soap bubbles and would drift away and pop over the ocean somewhere, drowning out any of the positive ideas that were presented.

But, apparently, somebody was listening!

ACOG says, “Women and their physicians may still make a plan for a TOLAC in situations where there may not be ‘immediately available’ staff to handle emergencies, but it requires a thorough discussion of the local health care system, the available resources, and the potential for incremental risk. ‘It is absolutely critical that a woman and her physician discuss VBAC early in the prenatal care period so that logistical plans can be made well in advance,’ said Dr. Grobman. And those hospitals that lack ‘immediately available’ staff should develop a clear process for gathering them quickly and all hospitals should have a plan in place for managing emergency uterine ruptures, however rarely they may occur, Dr. Grobman added."

One of the most heinous aspects of the VBAC Wars has been when women have been forced, by law and/or physical force to have a repeat cesarean. Women have been cut open even as they screamed “I refuse consent!” One of my own clients had a baby at +2 station, shoved back up so she “could” have a cesarean. I tell the story in “Forced Cesarean.” I still get sick to my stomach remembering the experience; nothing like what the mom feels, I’m sure. Addressing this issue, ACOG says:

“The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during prenatal care, a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to refer her to another physician or center.”

“However, more than a revision of the VBAC Practice Bulletin is required to reverse the over a decade long trend of increasing cesarean rates and decreasing VBAC rates. ICAN challenges ACOG to take an active role in educating both women and practitioners about healthy childbirth practices; practices that not only encourage VBAC but discourage the overuse of primary cesareans.”

The LA Times says:

“The National Institutes of Health report combined with ACOG's new guidelines have the potential to usher in a new era of childbirth in the United States, returning it to a more natural, less-invasive event. Women's health experts nationwide have long agreed that one-third of all births by surgery is unnecessarily high. But, no matter what the medical evidence says, whether the attitudes of doctors and women will change to favor a less-invasive and medicalized — as well as slower and less convenient — approach to childbirth remains to be seen.”

I know many more commentaries will be born in the next couple of days.

I am absolutely shocked to read the new guidelines. I know many women don’t believe one word ACOG says, but I can’t help but pray/dream that this statement might actually cause a seismic shift in maternity care.

Elective cesarean sections are too risky, WHO study says

Despite medical advances and increasing access to improved obstetric care across the globe, surgical childbirths are still more risky for both mother and baby, according to an ongoing international survey by the World Health Organization (WHO).

A new report from the survey, which was published online today in the medical journal The Lancet, found that in Asia-in both developed and developing nations-cesarean section births only reduced risks of major complications for mother and child if they were medically recommended. Elected surgical deliveries, on the other hand, put both at greater risk.

"Cesarean section should be done only when there is a medical indication to improve the outcome for the mother or the baby," the authors of the report concluded. Common reasons for a recommendation for cesarean delivery included a previous cesarean section, cephalopelvic disproportion (when the baby's head cannot fit through the mother's pelvic opening) and fetal distress.

In the nine countries studied (Cambodia, China, India, Japan, Nepal, the Philippines, Sri Lanka, Thailand and Vietnam), more than a quarter of the 107,950 births analyzed (27.3 percent) were C-sections, and in China, which had the highest rate of operations, nearly half (46.2 percent) of the births in the survey were cesarean. With these surgeries comes increased risk of maternal death, infant death, admission into an intensive care unit, blood transfusion, hysterectomy or internal iliac artery ligation (to control bleeding in the pelvis) compared to spontaneous vaginal delivery, according to the report.

But these risks have not necessarily been absorbed into popular, or even medical culture. The rates of cesarean section procedures are on the rise in many countries across the globe, the authors report, and in some countries they "have reached epidemic proportions." Among the nations studied, China had the highest rate of cesarean sections that were performed without medical indication-11.7 percent; the overall rate for the facilities studied had a rate of 1.9 percent.

Most cesarean sections (15.8 percent of births) were begun during labor, as opposed to before it starts. But these later procedures-both elected (0.5 percent) and medically required (15.3 percent)-also carry the most risks for adverse outcomes, the authors found.

In a commentary accompanying the report, Yap-Seng Chong of the National University of Medicine in Singapore and Kenneth Y C Kwek of the KK Women's and Children's Hospital also in Singapore call the results "surprising and chilling." The findings, they say "should help us to prioritize our strategies to reduce unnecessary interventions in childbirth," they wrote. "There is little wrong with medical interventions when indicated, but for those who are still inclined to consider caesarean delivery a harmless option, they need to take a cold hard look at the evidence against unnecessary cesarean section."

The investigators were able to analyze some 96 percent of the births reported in the 122 hospitals that participated in the survey over two to three months between 2007 and 2008. Facilities were located in the capital city of each country and two randomly chosen regions. To qualify for the survey, hospitals had to be delivering at least 1,000 babies a year and performing cesarean surgeries, so as the authors noted, "the results therefore cannot be generalized to smaller facilities" or to the countries overall.

Despite the increased risks associated with cesarean deliveries, no mothers or babies in the study died after an elected cesarean before hospital release. The most dangerous form of childbirth proved to be vaginal operative delivery, which includes using forceps or a vacuum to assist in delivery and is more rare, occurring in just 3.2 percent of the births analyzed.

The findings confirm a previous WHO report published in 2006 in The Lancet, analyzing the rates and safety of various childbirth approaches in Latin America, where the investigators found that "increasing rates of cesarean section do not necessarily lead to improved outcomes and could be associated with harm." Taking the two reports together, the authors concluded, lends "strong multiregional support for the recommendation of avoiding unnecessary cesarean sections."

Surgical childbirth also requires more resources than a natural vaginal delivery, the authors note. Especially in countries where money, medical practitioners or proper equipment is more limited, unnecessary cesarean sections can drain resources away from those cases in which it can improve the chances of a healthy mother and baby.

"A successful VBAC occurs about 73% of the time. If a hospital bans VBAC, they’re basically telling 73% of women that they have to undergo a surgical procedure that carries more morbidity than if they had a vaginal birth. That’s outrageous to me." Dr. Stuart Fischbein

There seems to be a trend of scaring moms about the size of their babies. I have had friends who have had elective cesareans because their OB said their baby was too big to deliver vaginally. No "trial of labor" instead straight to the OR, which puts them and their baby more at risk. The ACOG says that macrosomia (suspected big baby) is not a good reason for Induction or Cesarean. So if an OB or Midwife recommend this, question it, ask what does ACOG recommend with macrosomia? Then whip this out of your purse. ACOG Guidelines of Fetal Macrosomia - They have removed this statement (maybe too many moms were bringing it into their OBs) so here is a statement by the American Family Physician on macrosomia.

I even know a mom who had a previous vaginal birth, so a "proven pelvis", the OB said, baby will be TOO big and scheduled a cesarean. I suggested she could choose to get a second opinion, she didn't (was tired of being pregnant, big and uncomfortable) and the baby was born by cesarean and was smaller than her first vaginally born baby. A very unnecessary operation, with a long recovery (LOTS of discomfort) for a mom with a toddler and newborn to take care of.

I understand that OBs are trying to cover their butts, I understand that it is more convenient to schedule and induction or even more convenient and they make more money with cesareans. But is it ethical to give only partial information to these moms? Do they say, your ultrasound makes it seem like the baby is possibly going to be 10 pounds, but they can be off by up to 2 pounds, so it is possible your baby is only 8 pounds. Do they say, I would like to induce you, but your bishops score is only 3 and you are most likely going to end up with a cesarean. Do they say elective cesareans are actually more risky than vaginal births for both mom and baby?

The probably more common approach is for OBs to suggest moms be induced because their babies are getting too big. Many moms at the end of their pregnancy are feeling uncomfortable and are looking for a way to get this baby out, the sooner the better. They are not told the risks of induction, not told their Bishops Score, nor told they are possibly setting themselves up for a cesarean.

Let us also remember that the American College of Obstetricians and Gynecologists do not recommend induction for a big baby, let alone cesarean. Big babies are also known as macrosomia. They have recently found that in addition to it being really difficult to tell the big babies from the regular sized babies via ultrasound, that when you induce a woman who is suspected to have a large baby, she is more likely to have a cesarean section. So it is better to just let nature take its course and all will be well. Especially if the mom is able to move around and push in more upright positions.

Lets think of a few things.... what is considered a BIG baby? I had 2 babies around 9 pounds, one exactly 9 pounds and 1 a bit bigger. Everyone seemed very impressed that I had pushed these HUGE babies out of me. Well, did they forget that is exactly what my body is supposed to do? My vagina is meant to stretch, my pelvis is meant to open, my body will grow the perfect size baby for me.

Statistically and medically a 9 pound baby is in the average range.

"Babies weighing more than 9 pounds and 15 ounces (4,500 grams) are considered much larger than average. (Average newborn weight is 7 pounds and 8 ounces.) It's very difficult to determine whether a baby is truly macrosomic (literally "of large body") while she's still in the womb — only a post-birth weigh-in confirms it."

ACOG recommends intervention only if baby is over 5000 grams which is 11 pounds. Keep in mind they admit there is NO WAY to know how much a baby will weigh until after the baby is born. So if they think by ultrasound a baby will be 11 pounds... the baby could actually only be 9 pounds, well within normal.

What about the simple fact that just saying your baby is getting to big, what does that do to a moms thought process? We are suggestible, especially at times when a person who has "authority" says something. How many moms are psyched out of birthing their babies the way their body knows how to, but that seed of doubt is planted by their care provider.

But the ultrasound says ______ fill in the blank. "A study comparing fetal weight estimates of clinicians, multiparous patients and ultrasonography found that ultrasound was the least accurate of the three methods.13 Limitations in the sensitivity and specificity of ultrasound have been observed in other studies.15 Despite these limitations, clinicians continue to incorrectly believe that ultrasound is an accurate way of predicting macrosomia.17 " link from http://www.aafp.org/afp/20010115/302.html

You decide what YOU want. Do your research and follow your gut. Do you trust your body to grow the right size baby for you? I know when Carson was born (my first VBAC 9lbs 4oz) my OB said, "If I had known he was that big I wouldn't have let you try for a VBAC." My response was, "Thank goodness you didn't know, because I obviously could do it." Would I have been strong enough to fight for my VBAC if she had doubted in me? I would like to think yes... I know for sure when I was getting huge with Bryson, I knew there would be nothing stopping me from delivering vaginally as long as I was ok and baby ok... size was irrelevant!

That really is a shame, many OBs do see birth as a medical problem instead of a natural event. They are also used to most of their moms having epidurals, which can make pushing any size baby out a bit more challenging at times.

Some good questions to ask are.... "Is Mom OK? Is Baby OK?" If the answer to those are yes, then it isn't medically necessary.

Wow. Thanks on all the info and support Ladies!. and Thanks on the pic comment! lol ^_^

Lots more info and support available!!!

:-D

Reluctant doctors like to believe that they haven't much influence over
their patients, but that is clearly not the case. Several studies have
found that when doctors genuinely encouraged women to have VBACs, most
of them did, and when they said nothing or acted neutral, most women
didn't. Finally, when obstetricians discouraged VBAC in women who
wanted to try it,none of them did.

I was told the same at about the same time, that my son would likely be 10 lbs plus by the time I delivered...although no one suggested that as being a reason for a c-section. My son was born at 7lbs 6 oz. He went him just under 7lbs...he was a tiny thing!

Ultrasound are not infallible. They are only estimations...don't bank on them, and don't let an ob BANK on you.

With my VBAC if they had said that my son was going to big my response would have been "so what." Your body is not going to make a baby too large for you to birth, and rupture is very rare, and inducing or bringing on labor prematurely can increase rupture rates when allowed to go to term and labor spontaneously the rupture rate is almost the same and with a non VBAC vaginal delivery. Say no, and keep saying no. Don't sign anything. Don't go in until time to push. Get a doula (wonderful person). You can do it.

That being said I know a wonderful woman who VBACed a 10+lb baby just fine.

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